Elisa Reyes has come to Plaza del Sol Family Health Center for doctor’s appointments for more than a decade. Though she moved away a while ago, the 33-year-old keeps returning, even if it means a two-hour roundtrip bus ride.

This is due to the fact that her two kids go to the same doctor as she does. This allows her to visit without a prior appointment when she is ill. The team at the Queens clinic also assisted her in obtaining health insurance and food stamps.

Reyes expressed in Spanish that he feels at ease and welcomed since they also speak his language. He feels a sense of belonging.

Plaza del Sol is one of two dozen sites run by Urban Health Plan Inc., which is one of nearly 1,400 federally designated community health centers. One in 11 Americans rely on these to get routine medical care, social services and, in some cases, fresh food.

The clinics act as an essential safety net across all states and U.S. territories for individuals of all ages who have low incomes. However, this safety net is currently under strain.

From 2012 onwards, there has been a 45% rise in the number of individuals seeking medical assistance at community health centers. To cater to this growing demand, these centers have also expanded their presence by establishing over 15,000 service locations.

Several facilities are understaffed and facing difficulties in recruiting physicians, mental health experts, nurses, and dentists. According to leaders, funding is a constant source of worry, with the ongoing discussions about the national budget making it nearly impossible for them to make long-term plans and hire staff.

However, the centers are actively working to enhance the health and accessibility of primary care within their communities, despite the existence of inequalities that begin long before a patient even enters an examination room.

Community health centers have been around, in some form, for decades, and they are largely what remains to serve a community when urban and rural hospitals close or cut back.

According to Dr. Matthew Kusher, who is the clinical director at Plaza del Sol, there are limitations to what prescriptions can do. For instance, they cannot prevent the spread of flu and COVID-19 in apartment complexes where families share one room and it is not feasible to isolate individuals.

Kusher stated that our contribution here only makes up 20% of someone’s overall health. Other factors, such as poverty and limited access to food, clean water, and clean air, have a greater impact on their health.

According to the U.S. Health Resources and Services Administration, 90% of patients at health centers have a household income that is equal to or less than 200% of the federal poverty line. Additionally:

In 2022, approximately 1.4 million individuals who received care at health centers were homeless.

— 20% of the population was without insurance coverage.

Half of the group were covered by Medicaid.

Approximately 25% of individuals were better assisted in a non-English language, with approximately 63% belonging to racial or ethnic minority groups.

“Il est essentiel que nous affrontions ces disparités directement dans les communautés qui en ont le plus besoin”, a déclaré le Dr Kyu Rhee, président de l’Association nationale des centres de santé communautaires. “Nous avons une main-d’œuvre qui travaille sans relâche, avec diligence, qui est résiliente et diversifiée – qui représente les personnes qu’elle sert. Et cette confiance est si cruciale.”

Yelisa Sierra, the specialty case manager at Plaza del Sol, often receives inquiries about individuals in need of clothing, food, or shelter. Recently, the clinic has been assisting a significant number of newly arrived migrants. Sierra wishes she had a more satisfactory response to the most common question she receives: Where can these individuals find employment?

“It’s not just a physical necessity, it’s also emotional,” stated Sierra as she sat in a small office adjacent to the busy waiting area. “Patients require someone who will listen to them. Sometimes, that’s all they need.”

Half a century ago, Dr. Acklema Mohammad began working as a medical aide at San Juan Health Center, the first clinic of Urban Health Plan. She has provided care for multiple generations of families.

She expressed how fulfilling it is to be a part of this community. Whenever she enters a door or walks along the street, she receives warm hugs from people. They greet her with excitement, saying, “Oh, Dr. Mo! You’re still here!”

Mohammad is most concerned about staffing. Due to the peak of the pandemic, numerous pediatricians either retired or sought employment elsewhere. However, it is not solely a financial concern. Mohammad has expressed that job seekers often prioritize quality of life and flexibility, seeking a work schedule without weekends or excessive hours.

Mohammad stated that the task at hand is significant and poses a major challenge due to the high number of ill children and patients. However, there is a shortage of healthcare providers to attend to them.

She mentioned that former pediatricians are occasionally taking on virtual appointments to offer assistance, and telehealth is also beneficial.

If patients are unable to utilize telehealth services, El Nuevo San Juan Health Center makes an effort to provide them with in-person care. According to Dr. Manuel Vazquez, the vice president of medical affairs at Urban Health Plan who manages the home health program, approximately 150 elderly individuals receive visits at their homes.

Sometimes, the home visit is not included in coverage, but the team performs it regardless and does not receive payment.

He stated, “We refused. This must be done.”

In 1967, following the Freedom Summer of the Civil Rights Movement, a community health center was established in the rural Mississippi delta, making it one of the first in the nation.

The Delta Health Center, located in Mound Bayou, Mississippi, currently has 17 locations across five counties. These include both standalone clinics and ones situated within schools.

Employees are facing long-standing issues such as food insecurity and lack of transportation. They are offering culinary lessons and utilizing produce from the community garden. Additionally, a clinic has been established in the neighboring town of Leland, with Saturday hours, to accommodate the approximately 4,000 residents who may not have access to a vehicle and cannot make the 15-minute drive on the highway to Greenville, the closest small city. Unfortunately, there is no public transportation available.

That kind of access to preventive health care is critical as area hospitals cut back on neonatal services and other specialty care, said Temika Simmons, Delta Health Center’s chief public affairs officer.

She stated that in the event of a heart attack, one must be transported by air to Jackson or Memphis, where they have the necessary equipment to save their life. There is a possibility of not surviving the journey.

One important factor in the centers’ capacity to address health inequalities is their knowledge and involvement in their local communities.

Plaza del Sol is located in the heavily immigrant, mostly Latino neighborhood of Corona, which was the epicenter of New York City’s COVID-19 spread. Staff are required to speak Spanish. They regularly go to a local church to host vaccination clinics that reach hundreds. Center director Angelica Flores-DaSilva said a local principal will call her directly and ask for help to vaccinate kids so they don’t get disenrolled.

In Mississippi, employees are educated to identify indications of mistreatment, or recognize that a person who is protesting about completing a form may have difficulty reading. They distribute clothing, meals, and assistance as if it is available to all.

According to Simmons, individuals are skilled at concealing their situations. They are able to mask illiteracy, poverty, and abuse effectively. They are adept at choosing their words carefully.

In order to meet the needs of the communities, leaders of the center are doing their best to make the most of limited resources, but they require additional support.

According to an analysis sponsored by the National Association of Community Health Centers, federal funding for centers would need to rise by $2.1 billion in order to match the 2015 funding levels, due to the increasing number of patients and inflation in the health care industry.

Simmons advised, “Do not let the problem consume you. Instead, approach it by focusing on one day and one patient at a time.”

___

Data journalist Kasturi Pananjady from the Associated Press contributed to this report.

___

The Robert Wood Johnson Foundation provides financial support to the Associated Press Health and Science Department. The AP is solely accountable for all of its content.